One thing disability insurance providers like to do is to hire private investigators to film claimants and use the footage to deny benefits to those individuals. While the goal is to combat fraudulent filings, many times innocent people are caught in these traps and lose benefits they desperately need. If you find yourself being unjustly denied benefits because of something like this, here are three ways you can fight back.
Provide a Reasonable Explanation
Typically, the insurance company will cry foul when video recordings show claimants performing activities they're not supposed to be doing based on the type of injuries they sustained. For instance, a provider may accuse someone of fraud if that person claimed he or she couldn't get around without a wheelchair but a private investigator catches the individual on camera walking normally.
However, the trajectory for healing from an injury is not always a straight line, and it's common for patients to have a mix of good and bad days. For instance, a person suffering from severe back pain that leaves them hobbled over may be able to stand upright due to a new assistive device (e.g. back brace) or improved pain therapy.
Thus, you can counter an accusation of fraud by providing a reasonable explanation of your actions in the video and back up your claims with supportive evidence, such as an updated report from your healthcare providers or receipts for the purchase of medical devices and documentation showing their effect on injuries of your kind. This can help the company better understand your situation and prevent a denial of benefits.
Dispute the Conclusions Drawn
Sometimes, in their zeal to catch bad actors, insurance companies will draw the wrong conclusions when evaluating video footage of claimants. This can occur for many reasons, such as a low-quality recording, poor editing, or inaccurate information. For instance, the video shows an injured person exercising but doesn't indicate the individual is doing so during a physical therapy session, leading the insurance company to erroneously conclude the person is participating in an unapproved activity.
In this instance, request a copy of the video the company is basing its decision on and counter the conclusions the provider drew from it. If the insurance company has a video of you walking around without your neck brace, for instance, they may conclude your injury isn't as severe as you claim. Let them know why you weren't wearing your brace at that particular moment (e.g. it was aggravating your injury), and follow up with reports and X-rays confirming you're hurt to the degree you stated in your claim.
Dispute the Video's Validity
Although it doesn't occur often, sometimes insurance companies will base their decisions on video recordings that have been deceptively edited to make it appear the subjects are engaged in fraudulent behavior. For instance, a growing problem for society as a whole is the issue of criminals using AI deepfake technology to create convincing videos of people doing or saying things they've never done.
That's not to say someone would go through all the trouble and expense of making a deepfake video just to deny benefits to a claimant, but even something as simple as altering the time and date stamp on a video or splicing the footage to create an alternate story to what the unaltered footage shows can be enough to result in a denial of benefits for a claimant.
Fortunately, there are professionals who can view video recordings and tell whether the footage is real, fake, or has been edited in some way, and you can use their expertise to help prove the video evidence the insurance company is using is not legit. If you suspect fake footage may be an issue in your case, it's best to talk to an attorney who can help you connect with the right experts. Be aware, though, that their services are not cheap, so you should make sure what you'll gain will exceed the expense.
For more tips on handling this issue or assistance with your disability claim, contact a long-term disability lawyer.